Provider Demographics
NPI:1548027964
Name:EDNACOT, KARYNNE F (FNP-C)
Entity type:Individual
Prefix:
First Name:KARYNNE
Middle Name:F
Last Name:EDNACOT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 TABER DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-7038
Mailing Address - Country:US
Mailing Address - Phone:619-395-5783
Mailing Address - Fax:
Practice Address - Street 1:340 4TH AVE STE 4
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3885
Practice Address - Country:US
Practice Address - Phone:619-427-1144
Practice Address - Fax:619-427-1185
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021633363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner